| Author | 4 Posts |
Justice
Forum Fanatic
Topics: 117
Posts: 2,324
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Please vote with your answer
A 43-year-old male farmer comes to your office because he developed a blister at the vermilion border of his lower lip yesterday morning. He has a long history of similar lesions, which he refers to as cold sores. He mentions that the lesions often appear after extended periods in the sun. The patient denies fever or fatigue and otherwise feels well.
Physical examination is normal except for one blister on his lip.
Which of the following is most appropriate at this time?
A. Obtain a virus culture of the lip lesion
B. Prescribe a topical antibacterial ointment to be started today
C. Prescribe a 7-day course of oral acyclovir to be started today
D. Prescribe topical penciclovir to be started today
E. Prescribe no treatment now; discuss the option of immediate self-treatment with topical penciclovir for future episodes
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| DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
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HSV-1 Herpes cold sores and a long history
D and E are very similar but since he has a history of these cold sores with sun exposure, with no other systemic signs, he should be able to use a cold sore cream by himself for future recurrences.
I go with:E. Prescribe no treatment now; discuss the option of immediate self-treatment with topical penciclovir for future episodes
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| guangyu
Forum Elite
Topics: 29
Posts: 308
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i think it is C
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| Justice
Forum Fanatic
Topics: 117
Posts: 2,324
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The correct answer is E
Recurrent herpes labialis is a self-limited illness for which interventions are probably of marginal value. Use of topical penciclovir was found to have small but statistically significant benefits in the management of herpes labialis (time to healing and loss of pain were reduced by less than 1 day when patients began application within 1 hour of the first sign or symptom and applied the drug every 2 hours while awake for 4 days). An over-the-counter cream containing a long-chain alcohol, docosanol (Abreva ®), is also FDA-approved for herpes labialis and has benefits similar to those of penciclovir when started within hours of the onset of symptoms. Recently, valacyclovir was approved for 1-day treatment of orolabial herpes, using two large oral doses 12 hours apart. Another possibility is to prescribe oral acyclovir in an attempt to suppress frequent recurrences or prevent sun-induced episodes of herpes labialis. Although there is support in the literature for this approach, acyclovir is not FDA-approved for this indication.
A culture to confirm the diagnosis of uncomplicated herpes labialis is unnecessary. Antibacterial agents are not indicated for treatment of viral infections and should not be used to prevent bacterial superinfections. No treatment would be expected to help if started the day after the lesion was noted.
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